Burns and Scalds First Aid: Pain Control, Comfort Measures, and Hydration

1) Non-drug comfort measures

After the initial first-aid steps are underway, comfort measures help reduce pain, limit swelling, and prevent the injured area from being bumped or rubbed. These steps are suitable for non-professionals and can be used alongside appropriate over-the-counter (OTC) pain relief.

Finish cooling safely (without overcooling)

Even after the main cooling period, the skin can keep “holding heat.” If the area still feels hot, gently continue cooling in short bursts. The goal is comfort and temperature normalization—not making the person cold.

• Use brief re-cooling: apply cool (not icy) water or a cool compress for 1–2 minutes, then stop and reassess pain and skin temperature.
• Stop if shivering or pale/clammy skin develops: shivering is a sign the body is getting too cold; switch to keeping the person warm overall while protecting the burn.
• Avoid ice directly on skin: it can worsen tissue injury and increase pain.

Elevation to reduce throbbing and swelling

Swelling can increase pressure and pain, especially on hands, feet, and around joints. Elevation helps fluid drain away from the area.

• Position: raise the burned limb above heart level when practical.
• Support: use pillows, folded towels, or a sling so the person can relax without holding the limb up.
• Recheck comfort: if elevation increases pain (for example, due to tightness from swelling), adjust to a slightly lower position and reassess.

Gentle protection to reduce friction and air exposure

Air movement, clothing rub, and accidental bumps often make burns feel much more painful. Gentle protection is a major comfort tool.

• Keep the area still: limit movement of the burned joint/limb when possible.
• Prevent rubbing: choose loose clothing around the area; avoid tight sleeves, socks, or straps.
• Reduce pressure points: if the burn is on the back of the arm or leg, reposition so the person is not lying directly on it.

Simple calming measures (pain amplification control)

Pain is influenced by stress, fear, and overheating. Reducing these can noticeably improve comfort.

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• Keep the person comfortably warm overall (blanket over uninjured areas) while the burn itself is protected.
• Slow breathing: encourage slow, steady breaths during dressing changes or movement.
• Distraction: conversation, music, or a simple task can reduce perceived pain, especially in children.

2) Over-the-counter pain relief principles and common cautions

OTC pain medicines can reduce pain enough to allow rest, hydration, and gentle movement. Use only one product at a time unless you are sure the ingredients do not overlap. If the person has significant medical conditions, is pregnant, is on blood thinners, or you are unsure what is safe, choose non-drug comfort measures and seek medical advice.

Core principles for safe OTC use

• Use the lowest effective dose for the shortest needed time.
• Read the label every time (different brands have different strengths).
• Avoid double-dosing: many cold/flu products contain pain relievers already.
• Track timing: write down the time and dose to prevent accidental repeat doses.

Common OTC options (general guidance)

Age limits and special populations

• Children: use only products labeled for the child’s age/weight; dosing is often weight-based. If unsure, do not guess.
• Older adults: higher risk of stomach bleeding and kidney strain from NSAIDs; consider acetaminophen if appropriate and within label limits.
• Pregnancy: medication choices can change by trimester and individual risk; when uncertain, avoid self-medicating and seek professional guidance.

Allergies and intolerance

• Known allergy: do not give a medication the person has reacted to before.
• NSAID sensitivity: some people with asthma or nasal polyps react to NSAIDs; if there is a known history, avoid NSAIDs.

Stomach, kidney, and bleeding considerations

Burn pain can tempt people to take “a bit more” or combine products. This is where harm often occurs.

• NSAIDs and stomach: can irritate the stomach lining and increase bleeding risk—especially with alcohol, steroids, or a history of ulcers.
• NSAIDs and kidneys: kidneys are more vulnerable when the person is dehydrated (vomiting, not drinking, heat exposure). If the person is not keeping fluids down, avoid NSAIDs unless a clinician advises otherwise.
• Blood thinners: NSAIDs can increase bleeding risk; seek advice.

Avoiding overdosing: a simple tracking method

Use a quick “med log” to prevent accidental repeats, especially when multiple caregivers are present.

Medication log (example)  Name: ___________  Date: ___________  Weight (child): ______  Time  Medicine  Dose  Given by  Notes  14:00  Acetaminophen  ___ mg  ____  pain 7/10  18:00  Ibuprofen  ___ mg  ____  ate snack first

If you cannot confirm what was already given, do not give another dose until you can verify the timing and ingredient.

3) Nausea or faintness after burns and how to position the person safely

Some people feel nauseated, lightheaded, or faint after a burn due to pain, stress, heat exposure, or seeing the injury. The priority is preventing falls, protecting the airway if vomiting occurs, and keeping the person calm and cool (without chilling them).

Warning signs that need extra caution

• Lightheadedness, sweating, pale/clammy skin
• Nausea or repeated retching
• Feeling “about to pass out,” weakness, or unsteady standing
• Brief fainting episode

Step-by-step: if the person feels faint

• Get them down safely: help them sit or lie down immediately to prevent a fall.
• Position: lie them flat and, if tolerated, raise legs slightly (for example, on a pillow) to improve blood flow to the brain.
• Loosen tight clothing around neck/waist and ensure fresh air.
• Reassure and slow breathing: pain and panic can worsen faintness.
• Do not give food/drink until fully alert and nausea has settled.

Step-by-step: if the person is nauseated or might vomit

• Side-lying position: place them on their side (recovery position) to reduce choking risk if vomiting occurs.
• Protect the burn: ensure the injured area is supported and not pressed against the floor or bed.
• Small sips later: once fully alert and vomiting has stopped, offer small sips of water or oral rehydration solution.

When faintness is not “just stress”

If faintness is persistent, recurrent, accompanied by confusion, chest pain, trouble breathing, or the person cannot stay awake, treat it as a medical concern and seek urgent help.

4) Hydration guidance for minor burns

For minor burns, good hydration supports circulation, temperature regulation, and overall recovery. Pain and stress can reduce appetite and drinking, so hydration often needs to be intentional.

What to drink

• Water is usually sufficient for minor burns.
• Oral rehydration solution (ORS) is helpful if the person has been sweating heavily, has mild nausea, or has had vomiting/diarrhea.
• Avoid alcohol (dehydrating and can increase bleeding risk with some medicines).

How much and how fast

Rather than forcing large amounts at once, aim for steady intake.

• Start with small, frequent sips if the person is nauseated or in significant pain.
• Practical target: pale yellow urine and regular urination are simple signs of adequate hydration for most people.
• If using NSAIDs: ensure the person is drinking normally; avoid NSAIDs if they are dehydrated or cannot keep fluids down.

Hydration tips that improve success

• Offer a drink every 15–30 minutes for the first couple of hours if the person is not drinking spontaneously.
• Use a straw or sports bottle to reduce movement if the burn is on the hand/arm.
• If the person is a child, offer small amounts more often and use familiar cups to reduce resistance.

5) When pain level suggests the burn may be more severe than it appears

Pain is not a perfect “severity meter,” but certain pain patterns are red flags. Severe, escalating, or poorly controlled pain can indicate deeper injury, developing complications, or that the burn involves a high-risk area or mechanism.

Pain patterns that should raise concern

• Pain that is extreme or worsening despite cooling completion, protection, elevation, and appropriate OTC dosing.
• Throbbing pain with rapidly increasing swelling in a finger, hand, foot, or around a joint (especially if rings, watches, or tight items were present).
• Pain out of proportion to what you see on the skin, especially after chemical or electrical exposure.
• New numbness, tingling, or loss of function (for example, difficulty moving fingers) alongside pain.
• Pain that prevents drinking, sleeping, or normal movement for several hours.

Practical decision aid: reassess after comfort steps

Use a simple reassessment cycle to decide whether home care is still appropriate.

1. Apply comfort measures: brief re-cooling if still hot, elevate, protect from friction, calm environment.
2. Consider OTC pain relief if safe for the person and within label directions.
3. Recheck in 30–60 minutes: pain score, swelling, ability to move the area, ability to drink fluids, and overall alertness.
4. Escalate care if pain remains severe, worsens, or is paired with faintness, repeated vomiting, or functional changes.

When in doubt, treat unexpectedly high pain as a reason to seek medical advice—especially if the injury came from chemicals, electricity, pressurized steam, or a very hot liquid that soaked clothing.